Perioperative Education Modalities for ACL Reconstruction in Anterior Cruciate Ligament Injury

Overseen By Kaycee Glattke, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Mayo Clinic

Disqualifiers: Surgical revision, Multi-ligament injuries, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

105 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this research is to find out whether the way information about surgery is presented to patients affects patient satisfaction, knowledge retention, and surgical outcomes such as anxiety

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Classroom-Based Intervention, Video-Based Intervention for ACL reconstruction?

Research shows that using videos for patient education can improve patient satisfaction and outcomes by making information more accessible and consistent. This suggests that video-based interventions could be effective in helping patients understand and prepare for ACL reconstruction. ^{1 2 3 4 5}

Is it safe to use educational videos and classroom-based interventions for medical training?

Educational videos and classroom-based interventions are generally considered safe for medical training, as they are used to improve skills and adherence to protocols, which can enhance patient safety. ^{6 7 8 9 10}

How does the perioperative education treatment for ACL reconstruction differ from other treatments?

This treatment is unique because it focuses on perioperative education, which includes teaching patients about the surgery and recovery process, and involves a structured rehabilitation program starting from the time of injury. It emphasizes mental preparation and specific exercises to reduce swelling and improve knee movement, which is not typically a focus in standard treatments. ^{1 11 12 13 14}

Research Team

Hayley Powell, MSN, RN

Principal Investigator

Mayo Clinic

Eligibility Criteria

This trial is for English-speaking patients scheduled for primary ACL reconstruction surgery at Mayo Clinic Arizona. It's not open to medical professionals, those with multi-ligament knee injuries, sensory impairments, or a history of ACL surgery.

Inclusion Criteria

Patients with a proficiency in English in order to participate without need for translator.

Patients of Senior Attending orthopedic sports medicine surgeons at Mayo Clinic Arizona

You have a torn ACL and need surgery to fix it.

Exclusion Criteria

Patients who are medical professionals with work-related knowledge of ACL reconstruction.

You have multiple ligament injuries in your knee that require special post-surgery care to unload the knee.

Patients with an inability or unwillingness of individual or legal guardian to give written informed consent.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Education

Participants receive either video-based, virtual classroom, or standard of care education approximately 4 weeks before surgery

4 weeks

1 visit (virtual or in-person)

Surgery and Immediate Postoperative Care

Participants undergo ACL reconstruction surgery and receive immediate postoperative care

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety, effectiveness, and various outcomes such as patient satisfaction, self-efficacy, and surgical outcomes

24 months

Treatment Details

Interventions

• Classroom-Based Intervention
• Video-Based Intervention

Trial Overview The study compares two ways of educating patients about their upcoming ACL surgery: one uses videos and the other uses classroom instruction. The goal is to see which method leads to better patient satisfaction and surgical outcomes.

Participant Groups

Group I: Virtual Classroom Course Group Experimental Treatment 1 Intervention

Approximately 4 weeks before scheduled surgery, participants will receive the classroom-based intervention regarding pre-and postoperative care for ACL reconstruction.

Group II: Video-Based Education Group Experimental Treatment 1 Intervention

Approximately 4 weeks before scheduled surgery, participants will receive the video-based intervention regarding pre-and postoperative care for ACL reconstruction.

Group III: Standard of Care Group Active Control 1 Intervention

Participants will receive verbal and written pre-and postoperative instruction as typically received by all ACL reconstruction patients treated by the attending physicians before and after surgery.

Who Is Running the Clinical Trial?

Mayo Clinic

Lead Sponsor

Trials

3,427

Recruited

3,221,000+

Findings from Research

Patients undergoing ACL reconstruction with spinal anesthesia and a femoral nerve block experienced significantly lower pain levels in the first 6 hours post-surgery compared to those with spinal anesthesia alone, indicating effective early pain management.

However, after the third postoperative day, the femoral nerve block did not provide additional pain relief benefits, and both groups showed similar improvements in knee flexion and functional independence, suggesting that the nerve block may not be necessary for long-term recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block. Astur, DC., Aleluia, V., Veronese, C., et al.[2022]

The development of a preoperative videotape by an interdisciplinary team at the Albuquerque Veterans Affairs Medical Center led to improved patient satisfaction by enhancing the availability and consistency of preoperative instructions.

Preliminary data indicates that patients and their families found the videotape an appealing and effective addition to traditional preoperative teaching methods, aligning with JCAHO standards for patient education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A video approach to interactive patient education. Maller, CE., Twitty, VJ., Sauve, A.[2019]

In a study of 269 patients who underwent anterior cruciate ligament reconstruction (ACLR), 36.8% refilled their opioid prescriptions post-surgery, with factors like higher body mass index (BMI) and government insurance being significant predictors of increased opioid use.

Interestingly, 21% of patients received opioid prescriptions unrelated to their ACL reconstruction within two years, highlighting the need for careful monitoring of opioid prescribing practices in postoperative care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perioperative Opioid Use in Anterior Cruciate Ligament Reconstruction Patients. Aneizi, A., Friedmann, E., Henry, LE., et al.[2023]

In a study of 50 patients undergoing ACL surgery, it was found that prescribing a median of 15 oxycodone 5-mg pills resulted in only 34% of the prescribed opioids being consumed, indicating that current opioid prescription guidelines may be excessive.

Despite the lower opioid prescription, patients reported low pain levels (mean score of 2.8 out of 10) and high satisfaction with pain management (4.1 out of 5), suggesting effective pain control can be achieved with fewer opioids.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Opioid Requirement After Anterior Cruciate Ligament Surgery: Opioid Use After Anterior Cruciate Ligament Surgery Is Low With a Multimodal Approach, and Fifteen Oxycodone 5-mg Tablets Are Sufficient. Liddy, N., Kamdar, PM., Quintana, JO., et al.[2023]

Patients who underwent outpatient ACL reconstruction experienced similar rates of postoperative discomfort compared to those who stayed in the hospital, with 37% of outpatient patients reporting symptoms versus 41% of inpatient patients, indicating that outpatient management is a safe option.

Outpatient patients had significantly better sleep quality and mobility in the first night after surgery, suggesting that outpatient care may lead to a more comfortable recovery experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative discomfort after outpatient anterior cruciate ligament reconstruction: a prospective comparative study. Lefevre, N., Klouche, S., de Pamphilis, O., et al.[2016]

In a study of 8,975 pediatric patients undergoing 29 different orthopedic procedures, adverse events occurred in 3.92% of patients, with spinal fusion and external fixation associated with higher rates of complications.

Four deaths were reported, all in patients with nonidiopathic scoliosis undergoing spinal fusion, highlighting the need for careful monitoring of high-risk patients, particularly those with obesity or significant health issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Which Pediatric Orthopaedic Procedures Have the Greatest Risk of Adverse Outcomes? Basques, BA., Lukasiewicz, AM., Samuel, AM., et al.[2022]

A new approach to Morbidity and Mortality (M&M) Conferences has led to a 29% increase in overall satisfaction and a 50% increase in satisfaction regarding the addressing of process improvement issues over 5 years.

The hands-on, educational focus of the revamped M&M Conferences has resulted in 100% of faculty applying what they learn to their practice, suggesting that this model could enhance discussions about adverse events and improve patient safety across the medical community.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Innovative and Integrative Approach to Breaking Down Barriers to Traditional Morbidity and Mortality Conference. Tresselt, E., Darnell Bowens, C., Dhar, A.[2023]

The study involved medical students practicing suturing and knot-tying skills using different training methods, including self-study with video, interactive video, and expert instruction, with all groups showing significant improvement in skills after training.

However, there were no significant differences in skill development or retention among the three training methods, suggesting that computer-based video instruction alone is effective for teaching basic surgical skills without the need for additional expert instruction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of expert instruction and computer-based video training in teaching fundamental surgical skills to medical students. Nousiainen, M., Brydges, R., Backstein, D., et al.[2008]

The introduction of an educational video significantly improved adherence to safety protocols during anaesthesia procedures, reducing the odds of failure to follow critical tasks by 66% (odds ratio 0.34) in a study involving 425 procedures and 1091 team members.

The video intervention led to a significant reduction in adherence failures for eight out of fourteen safety-critical tasks, highlighting its effectiveness in enhancing patient safety during complex medical procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using educational video to enhance protocol adherence for medical procedures. Kandler, L., Tscholl, DW., Kolbe, M., et al.[2019]

Medical students who learned about acetaminophen toxicity through a video-based method scored significantly higher on post-tests compared to those who read a textbook chapter, indicating that video content may enhance knowledge acquisition.

A strong majority of students (78.4%) preferred video learning over traditional reading, and 93.3% reported satisfaction with the video format, suggesting that modern educational technologies are well-received and could improve medical education delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Video delivery of toxicology educational content versus textbook for asynchronous learning, using acetaminophen overdose as a topic. Vo, T., Ledbetter, C., Zuckerman, M.[2020]

ACL reconstruction is a common surgical procedure, with over 100,000 new injuries occurring each year, highlighting the importance of effective management and care for these patients.

The article emphasizes the significance of preoperative education and comprehensive nursing care throughout the surgical process to improve patient outcomes after ACL reconstruction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior cruciate ligament reconstruction. Bach, BR., Boonos, CL.[2022]

A comprehensive four-phase rehabilitation program, initiated at the time of injury and continuing post-surgery, has been effective in reducing complications and facilitating a quicker return to activity for patients undergoing anterior cruciate ligament reconstruction.

The program emphasizes early intervention strategies such as swelling reduction and gait training before surgery, followed by a focus on regaining knee motion and strengthening after surgery, which supports safe recovery and improved outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A perioperative rehabilitation program for anterior cruciate ligament surgery. Arnold, T., Shelbourne, KD.[2010]

The trend of performing anterior cruciate ligament (ACL) reconstruction as an outpatient procedure is increasing due to cost containment pressures from insurance companies, which allows for shorter hospital stays.

Nurses play a crucial role in the care of outpatient ACL reconstruction patients by assessing their needs, implementing care plans, and providing education throughout the preoperative, intraoperative, and postoperative phases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior cruciate ligament reconstruction as an outpatient procedure. Brown, FM.[2019]

A pilot study involving 26 patients showed that an app-based serious gaming program (GenuSport Knee Trainer) significantly improved postoperative strength after anterior cruciate ligament reconstruction compared to conventional rehabilitation, with a relevant difference in maximum strength change of 59.7 N (P=.02).

No adverse events were reported during the study, indicating that the app-based training is a safe and effective complement to traditional rehabilitation methods in the early postoperative phase.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach. Clausen, JD., Nahen, N., Horstmann, H., et al.[2020]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

A video approach to interactive patient education. [2019]

3. Germany pubmed.ncbi.nlm.nih.gov

Perioperative Opioid Use in Anterior Cruciate Ligament Reconstruction Patients. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Opioid Requirement After Anterior Cruciate Ligament Surgery: Opioid Use After Anterior Cruciate Ligament Surgery Is Low With a Multimodal Approach, and Fifteen Oxycodone 5-mg Tablets Are Sufficient. [2023]

5. France pubmed.ncbi.nlm.nih.gov

Postoperative discomfort after outpatient anterior cruciate ligament reconstruction: a prospective comparative study. [2016]

6. United States pubmed.ncbi.nlm.nih.gov

Which Pediatric Orthopaedic Procedures Have the Greatest Risk of Adverse Outcomes? [2022]

7. United States pubmed.ncbi.nlm.nih.gov

An Innovative and Integrative Approach to Breaking Down Barriers to Traditional Morbidity and Mortality Conference. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Comparison of expert instruction and computer-based video training in teaching fundamental surgical skills to medical students. [2008]

9. England pubmed.ncbi.nlm.nih.gov

Using educational video to enhance protocol adherence for medical procedures. [2019]

10. England pubmed.ncbi.nlm.nih.gov

Video delivery of toxicology educational content versus textbook for asynchronous learning, using acetaminophen overdose as a topic. [2020]

11. United States pubmed.ncbi.nlm.nih.gov

Anterior cruciate ligament reconstruction. [2022]

12. England pubmed.ncbi.nlm.nih.gov

A perioperative rehabilitation program for anterior cruciate ligament surgery. [2010]

13. United States pubmed.ncbi.nlm.nih.gov

Anterior cruciate ligament reconstruction as an outpatient procedure. [2019]

14. Canada pubmed.ncbi.nlm.nih.gov

Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach. [2020]